| NPI | 1619350725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019030226) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: IL 019.030226) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-07-07 |